Surgical strategy for benign sacral neurogenic tumor

English Keywords:Sacral  Nerve sheath tumor  Surgical approach

English Abstract:

  【Abstract】 Objectives: To discuss the most appropriate surgical strategy for sacral benign neurogenic tumor. Methods: Between June 2000 and December 2015, 188 cases(neurofibromas 137 cases, schwannomas 51 cases) with sacral neurogenic tumors were admitted and treated. There were 93 males and 95 females, with an average age of 42.3±10.4 years old(range, 17-75 years old). Among them, 167 patients were firstly treated in our hospital, and 21 patients were treated because of local recurrence after treatment in other institations. The diagnoses of sacral benign neurogenic tumors were made by imaging studies without biopsy before surgery. Giant presacral neurogenic tumors confined to the sacral canal or located below the S1 level were piecemeal removed in a posterior-only approach. Giant tumors above S1 level were removed in a anterior-posterior surgical approach. Giant presacral neurogenic tumors above S2 level could be resected in an anterior-only approach. The diagnosis of benign neurogenic tumor was confirmed by postoperative pathologic examination. Results: Surgeries lasted a mean of 185±61 minutes(range, 75-420 minutes). The mean estimated blood loss was 1600±908ml(range, 500-5000ml). Depending on the location and size of tumor, posterior-only approach was used in 165 cases, anterior-posterior surgical approach in 16 cases, and anterior-only approach in 7 cases. 9 cases with small tumors received en bloc resection, and the remaining cases received piecemeal resection. Among the 188 patients, one patient died in the perioperation period, 3 patients with huge tumor received the resection of nerve roots below the S2 level because of too much bleeding, which resulted in incontinence of feces and urine but without vesicostomy or rectostomy, all the other patients were operated with preservation of nerve roots above S3 level. The average period of follow-up was 59±21 months(range, 10-126 months). There were 16 patients suffered from local recurrence(8.5%). Conclusions: In surgical resection of sacral neurogenic tumors, surgical approach depends on the location and size of the tumors. Both en bloc and piecemeal resection can achieve satisfying clinical outcome.